الفهرس 
Introduction
hemodialysisOnly 14 pages are availabe for public view
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Abstract
End-stage renal disease (ESRD) is one of the main health problems
in Egypt. Currently, hemodialysis represents the main mode for treatment
of chronic kidney disease stage 5 (CKD5), previously called ESRD or
chronic renal failure.
Although hemodialysis is often used for treatment of ESRD, no
practice guidelines are available in Egypt. Healthcare facilities are
seeking nowadays to develop practice guidelines for the sake of
improving healthcare services. In the healthcare sector in Egypt, trials for
establishing guidelines have been lead by the MOH.
This work is a part of project aiming at Statement of the current
status of dialysis patient in Egypt using a questionnaire. This project is
modulated by Nephrology department, Ain Shams university.this study
was done in January to December 2013.
Our study sample consisted of 304 clinically stable chronic
patients on regular thrice- weekly HD. Patients were collected from Al
sharqia (Diarpnegm central hospital, El ibrahimia central hospital & Al-
Hesaneya central hospital).
In all patients we recorded full history and clinical examination
stressing on etiology of renal disease and associated complications,
Full review of all medical records over the last 6 months, and details
of H D prescription (Doctors, nurses, administration orders). Results of this study demonstrated that there were many causes for
ESRD in the study population, where HTN 46.7%, DM 16.1%, and in
12.2% the cause was unknown, this results agrees with most of the
studies where HTN & DM were the main causes of renal failure.
Different comorbidities in the study population were HTN in
(90.5%), DM in (18.1%), ISHD in (60.2 %), CLD in (46.4%) of patients.
In our study we found that most of the patients 70.1% recieve 3 HD
sessions /week each lasting 4 hours , this was with KDOQI guidelines
recommendations for HD adequacy .
The mean value of HD period is 6.6 (± 4.7) years. The mean value
of patients dry weight was 72.4 (± 16.4) Kg.
In our study population (94.7%) were not working, while (5.3%)
were working .
Dependency status in the study population showed that (27.3%) of
the patients were dependant, (72.7%) were independant , while (12.2%)
of them were wheelchair bound .
As regard Sponsoring status in the study population (93.8%) of
them were sponsored by Governorate , while (6.3%) of them were health
insurance.
In our study we found that 91.4% of patients were using AVF , 0.7
% were using AVG while 7.9 % were using long term cathter . this was in
agreement with KDOQI guidelines for venous access placement.
In our study the mean hemoglobin level of our patients was
10.64±(1.73)gm/dl , we found that according to NKF- KDOQI guidelines
recommendations (72.0 %) of our patients were below the recommended level, (28.0 %) were above it.
In our study the percentage of patients receiving regular
erythropoietin was (98.4%) , the most frequent ESA used was Epoetin
alfa (98.4%), ,while (1.8%) of patients were not on ESA therapy.
Our study no PTH level was done, recommendations of
KDIGO guidelines 2009 was to maintain its level 2-9 times the
upper normal limit of the assay.
As regard vitamins use in the study population (73.0%) of them
received vitamin B complex , as regard L-Carnitine (49.0%) of them
received it , as regard vitamin D there were ( 46.1%) of our patients
received it.
History of iron injection in the study population showed that
(92.4%) received iron injection, while the other (7.6%) did not receive it .
We also found that the mean calcium level was (8.4) ± (0.8)mg/dl ,
According to KDIGO 2009 guidelines 39.8 % of patients were below the
recommended level , 59.2 % within the recommended level and 1.0 %
above the recommended level.
In our study we found that the mean phosphorus level was (5.5) ±
(1.4) mg/dl. According to KDIGO 2009 guidelines 7.9 % of our patients
were below the recommended level, 47.4 % within the recommended
level and 44.7 %above the recommended level.
In our study 92.1% of the patients were on phosphate binder’s
therapy. Calcium phosphorus product level was above 55 in (13.8%) ,while
in (86.2%) was below 55.
The percentage of HCV positive Pts is (47.4%), HBV positive Pts
percentage is (0.0%), while (52.6%) of Pts are negative. all HCV positive
Pts are totally isolated from HCV negative.
Our study showed that (100.0 %) of Pts were using dialyzer with
surface area 1.3m, of synthetic material, sterilized by ethylene oxide, low
flux.
As regard dialysate used in the study population (62.8%) were
using dialysate with K concentration 2mmol/L, Ca concentration 1,75
mmol/L, Na 137 mmol/L, Mg 0.50 mmol/L and bicarbonate based, While
(37.2%) were using acetate based but with Calcium concentrraion
1.25mmol/L, Na 138 mmol/L.